The overall objective of the project is the investigation of biological factors contributing to psychosexual differentiation in general, and of management regimens (especially genital surgery and hormonal replacement therapy) that are likely to influence long-term behavioral functioning and quality of life in patients with intersexuality. For this purpose, we propose to evaluate aspects of the behavioral development and long-term outcome of adult women (age 18 years and up) with one of the major forms of the syndrome of congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency: prenatal-onset classical CAH (C-CAH, including both saltwasters, SW, and simple virilizers, SV) and non- classical or late-onset CAH (NC-CAH), and to search for associations of the behavioral phenotype with endocrine phenotype and molecular genotype. We expect that excess androgen exposure, especially during prenatal development, effects partial behavioral masculinization, in interaction with molecular genotype. Participants will be 50 women each with C-CAH-SW and C-CAH-SV, 100 women with NC-CAH, and 50 non- CAH adults sisters or female cousins of the patients. Assessments will include a battery of interviews, questionnaires, and psychometric tests covering mental health, gender identity and gender-related behavior, sexual functioning, selected cognitive abilities, and subjective quality of life, as well as a (mostly anthropometric) physical exam and historical data from the medical chart. The project will employ a quasi-experimental design for a cross-sectional comparison of the three endocrinologically and genetically defined groups of CAH patients to each other and to control women. The findings will contribute to our understanding of psychosexual differentiation in general and to the resolution of ongoing major controversies in the clinical management of patients with intersexuality.